Predictors of Hypotension After Induction of General Anesthesia

Reich, David L.; Hossain, Sabera; Krol, Marina; Baez, Bernard; Patel, Puja; Bernstein, Ariel; Bodian, Carol

doi:10.1213/01.ane.0000175214.38450.91

Cited by 475 publications

(388 citation statements)

References 12 publications

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“…Peak airway pressure was 16 (SD 3 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]) cmH 2 O. Airway seal pressure was 34 (SD 4 [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]) cmH 2 O. There were no important changes in measures of ventilation or oxygenation during the procedure.…”

Section: Resultsmentioning

confidence: 99%

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A case series of the use of the ProSeal laryngeal mask airway in emergency lower abdominal surgery

2008

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SummaryThe ProSeal laryngeal mask airway (PLMA) has been used routinely for anaesthesia and for difficult airway management including airway rescue in non-fasted patients. Compared with the classic laryngeal mask airway the PLMA increases protection against gastric inflation and pulmonary aspiration, by separating the respiratory and gastro-intestinal tracts. The PLMA has potential advantages over use of the tracheal tube including smoother recovery, reduced pharyngolaryngeal morbidity and even reduced postoperative pain. We report a series of patients scheduled for emergency appendicectomy, without other risk factors for regurgitation, managed with the PLMA. Anaesthesia was induced and maintained with remifentanil, target controlled propofol and rocuronium. A series of 102 cases were managed without complications and high rates of first time placement of the PLMA (inserted over a suction tube placed in the oesophagus). With careful patient selection the PLMA may offer an alternative airway for use by experienced anaesthetists in patients undergoing minor lower abdominal surgery.

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Section: Resultsmentioning

confidence: 99%

“…We maintained a consistently deep level of anaesthesia in our patients with infusions of propofol and remifentanil and low doses of rocuronium. We speculate that this, in addition to careful patient selection, may be important in safe use of the PLMA in these circumstances [22].…”

Section: Insertion On First Attemptmentioning

confidence: 98%

A case series of the use of the ProSeal laryngeal mask airway in emergency lower abdominal surgery

2008

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“…It was demonstrated that the use of ACE inhibitors was associated with advanced age, i.e., in the present study older patients were the ones who used ACE inhibitors, which might cause confusion. Another study that also used univariate, stratified, and logistic regression analysis to determine predictive factors of hypotension after anesthetic induction did not observe an association between the preoperative use of these drugs and hypotension 12 . We agree with the authors and reinforce the power of this type of statistical analysis on the determination of risk factors.…”

Section: Discussionmentioning

confidence: 96%

Influência do uso crônico dos inibidores da enzima conversora da angiotensina na hipotensão arterial após indução anestésica: é necessário suspender esse fármaco no pré-operatório?

Costa¹,

Caldas²,

Nunes³

et al. 2009

Rev. Bras. Anestesiol.

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COSTA, CALDAS, NUNES ET AL. commended 7 . In contrast, the discontinuation of drugs, such as angiotensin-converting enzyme inhibitors (ACE inhibitors) on the day of the surgery based on reports of significant hypotension after induction of anesthesia suggesting a deleterious interaction between ACE inhibitors and anesthetics in general has been questioned or suggested by some authors 8,9 . However, discontinuation of drugs used for a long time, such as antihypertensives, can implicate on a higher risk of intraoperative hypertensive peaks with harmful consequences for the patient 7 . This has generated controversies among anesthesiologists and, occasionally, conflicts with the physician in charge. The objective of this preliminary study was to evaluate the influence of the preoperative use of ACE inhibitors on the incidence of clinically significant hypotension (hypotension requiring intervention by the anesthesiologist) after anesthetic induction. METHODSAfter approval by the Ethics Committee of the hospital, a case-control, retrospective study in which the study group was composed by all patients who presented significant hypotension after anesthetic induction during the study period, i.e., one year, was undertaken. Cases of hypotension that required intervention such a volume expansion and use of vasopressors by the anesthesiologist responsible for the case were considered significant. Patients underwent orthopedic, neurosurgical, reconstructive plastic surgery, urologic, and thoracic procedures. Electronic medical records were reviewed for data on anesthetic induction, the moment the patient developed hypotension, therapeutic measures, and evolution of the case. The control group was composed by four patients, randomly selected, for each study patient, to increase the power of the statistical analysis 10 . Patients in the control group were in the same age range, underwent the same type of surgery and at the same time as the study patients, and did not develop hypotension after anesthetic induction. Patients younger than 18 years and those who received local anesthetics or sedation as the only technique were excluded from the study. Parameters analyzed were as follows: age, gender, size of the surgery, prior diagnosis of hypertension, use of ACE inhibitors, physical status (ASA), intraoperative bleeding, anesthetic technique, and duration of the surgery. Analysis of Variance was used for numerical parameters and Fisher's Exact test for categorical parameters. For categorical parameters with significant association, the degree of increase in risk was determined by odds ratio. Univariate and multiple analyses were also undertaken using logistic regressions. Data were processed by SPSS for Windows, version 13.0.

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“…[8][9][10][11][12] Various drug regimens and techniques have been used from time to time for attenuating the stress response to laryngoscopy and intubation, including opioids, barbiturates, benzodiazepines, beta blockers, calcium channel blockers and vasodilators etc. [13][14][15][16][17] Although the corresponding increases in blood pressure and heart rate are transitory and variable, they are more pronounced and unpredictable in patients with 19 % maximum increase in the heart rate after one minute of intubation and it was further decreased by 1.24% from the baseline.While patients of group B showed a 12% initial rise in pulse rate(at the first minof intubation) which did not return to the baseline even after ten minutes The maximum percentage increase in the SBP in Group B was 4%, while patients of Group A showed maximum percentage increase of only 0.29%.Dexmedetomidine group of patients also showed later a percentage decrease which was maximum at the third and fourth minutes (-0.61 %) raised intracranial tension, cardiovascular disease like hypertension following laryngoscopy.…”

Section: Discussionmentioning

confidence: 99%

A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

et al. 2018

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A B S T R A C TBackground: Laryngoscopy and intubation are associated with a sympathetically mediated circulatory response due to irritation of respiratory tract which is associated with increase in pulse rate and blood pressure that may be dangerous. Aims and Objectives: The aim of the present study was to determine and compare the efficacy of dexmedetomidine and fentanyl in attenuating the hemodynamic response to laryngoscopy and intubation and to detect any complication or side effect as a result of these drugs. Materials and Methods: Following approval by ethical committee, 60 ASA grade I and II patients of either sex undergoing general anaesthesia for elective surgery were included in this study. Patients were randomly divided into two groups of 30 patients each. Dexmedetomidine in a dose of 1µg/kg was given to Group A patients and Fentanyl 2 µg/kg was given to Group B patients. Both the drugs were diluted with normal saline solution to make 10ml and were administered slow intravenous 10 min before induction.The hemodynamic parameters were recorded, demographic data was analyzed using unpaired t-test and hemodynamic variables were analyzed by using unpaired and paired t-test. Side effects were analyzed using chi square test. Result: The two groups were comparable in their demographic profiles. Dexmedetomidine proved itself to be an excellent drug when given intravenously as a premedicant in dose of 1µg/kg to attenuate hemodynamic response to laryngoscopy and intubation. It blunted the hemodynamic response to laryngoscopy and intubation to a greater magnitude than fentanylin a dose of 2µg/kg intravenously as a premedicant. Conclusion: We conclude that fentanyl 2µg/kg i.v. given ten minutes prior to airway instrumentation shows an inconsistent response to laryngoscopy and intubation. Between the two drugs under study, the use of dexmedetomidine 1µg/kg i.v. is satisfactory and produces a more favorable hemodynamic profile while fentanyl 2µg/kg is found to be non-dependable and less effective for the attenuation of the pressor response to laryngoscopy and endotracheal intubation. However, further larger studies are required to strengthen these conclusions.

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Predictors of Hypotension After Induction of General Anesthesia

Cited by 475 publications

References 12 publications

A case series of the use of the ProSeal laryngeal mask airway in emergency lower abdominal surgery

A case series of the use of the ProSeal laryngeal mask airway in emergency lower abdominal surgery

Influência do uso crônico dos inibidores da enzima conversora da angiotensina na hipotensão arterial após indução anestésica: é necessário suspender esse fármaco no pré-operatório?

A comparative evaluation of dexmedetomidine and fentanyl to attenuate hemodynamic response to laryngoscopy and intubation

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